Management of patients during hunger strike and refeeding phase

Eichelberger, Markus; Joray, Maya Lucia; Perrig, Martin; Bodmer, Michael; Stanga, Zeno Giovanni (2014). Management of patients during hunger strike and refeeding phase. Nutrition, 30(11-12), pp. 1372-1378. Elsevier 10.1016/j.nut.2014.04.007

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OBJECTIVE Hunger strikers resuming nutritional intake may develop a life-threatening refeeding syndrome (RFS). Consequently, hunger strikers represent a core challenge for the medical staff. The objective of the study was to test the effectiveness and safety of evidence-based recommendations for prevention and management of RFS during the refeeding phase. METHODS This was a retrospective, observational data analysis of 37 consecutive, unselected cases of prisoners on a hunger strike during a 5-y period. The sample consisted of 37 cases representing 33 individual patients. RESULTS In seven cases (18.9%), the hunger strike was continued during the hospital stay, in 16 episodes (43.2%) cessation of the hunger strike occurred immediately after admission to the security ward, and in 14 episodes (37.9%) during hospital stay. In the refeed cases (n = 30), nutritional replenishment occurred orally, and in 25 (83.3%) micronutrients substitutions were made based on the recommendations. The gradual refeeding with fluid restriction occurred over 10 d. Uncomplicated dyselectrolytemia was documented in 12 cases (40%) within the refeeding phase. One case (3.3%) presented bilateral ankle edemas as a clinical manifestation of moderate RFS. Intensive medical treatment was not necessary and none of the patients died. Seven episodes of continued hunger strike were observed during the entire hospital stay without medical complications. CONCLUSIONS Our data suggested that seriousness and rate of medical complications during the refeeding phase can be kept at a minimum in a hunger strike population. This study supported use of recommendations to optimize risk management and to improve treatment quality and patient safety in this vulnerable population.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Endocrinology, Diabetology and Clinical Nutrition

UniBE Contributor:

Eichelberger, Markus; Joray, Maya Lucia; Perrig, Martin; Bodmer, Michael and Stanga, Zeno Giovanni

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0899-9007

Publisher:

Elsevier

Language:

English

Submitter:

Patricia Rajaonina

Date Deposited:

02 Apr 2015 16:27

Last Modified:

09 Nov 2015 10:48

Publisher DOI:

10.1016/j.nut.2014.04.007

PubMed ID:

25280415

Uncontrolled Keywords:

Hunger strike, Refeeding, Refeeding syndrome, Starving

BORIS DOI:

10.7892/boris.66067

URI:

https://boris.unibe.ch/id/eprint/66067

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